Healthcare Provider Details

I. General information

NPI: 1447471974
Provider Name (Legal Business Name): MARY RITA SZYMBORSKI RDMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S. WASHINGTON AVE
SAGINAW MI
48601
US

IV. Provider business mailing address

5965 WEISS APT. P-7
SAGINAW MI
48603
US

V. Phone/Fax

Practice location:
  • Phone: 989-907-8000
  • Fax:
Mailing address:
  • Phone: 989-790-2915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number111684
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: